Podcast Transcript Episode 11 – Nutrition For Constipation

The Ideal Nutrition Podcast

Aidan 

00:00:06 – 00:00:51

Hello and welcome back to The Ideal Nutrition Podcast. This is Episode 11 and today we are going to be talking about nutrition for constipation. For me, I’ve been a dietitian for, like, five years now. And for the first three or four years, I never had any clients have serious issues with this. Like it was always an easy fix, like we’d always just use some basic advice, and it will always get solved. And then one client came to me with, like, hectic issues, as in like when she wasn’t constipated, it was like every three days. And she was a bikini athlete as well, who obviously really cared about how she looked and like being bloated and stuff like that obviously made her very uncomfortable. And during this phase, her average turned to every 7 to 10 days, 

Aidan

00:00:51 – 00:01:21

and I was like, God damn, I don’t want anyone to live like this. Like this is an issue. Um, the standard advice obviously wasn’t working. She was getting medical care and stuff like that for it as well as you would need to do. And I was like, we seriously need to do a little bit more than this and I went really deep down the rabbit hole of trying to find stuff for nutrition and constipation. And when you look at studies, it’s surprising how little stuff really moves the needle. Like there’s not – like a lot of the common advice, which we’ll talk through a little bit later,

Aidan

00:01:21 – 00:01:54

Doesn’t really move the needle that much like sometimes it helps. But it’s like if we’re measuring things like, how frequently does this person go to the toilet? We want an intervention to improve that outcome and like there are even some interventions that might improve that outcome a little bit. But like then, they also happen to make bloating worse or like painful defecation worse. And like all these other symptoms get worse, even though that one outcome we care about improved a little bit. So it’s like it’s a really, really complex topic. So handing over to you, Leah, let’s start with, like, common advice and stuff like that, and we’ll move from there. Yeah?

Leah

00:01:54 – 00:02:19

Yeah, that sounds like a good plan. Um, I definitely come across constipation specific IBS or constipation in general a lot in the clinic. Um even though I work with predominantly vegans who eat a lot of fibre, you know, I still see it. So, um, there’s definitely a few things we can go over today that really do move the needle from a constipation perspective. But I will always start in the same place for every single person. 

Leah

00:02:19 – 00:03:02

And that is the three F’s: fibre, fluid, and fitness. Um, so really looking at is that person having adequate fibre? Most cases I work with are vegan so probably they are. Um, maybe they even are having a little too much in that case, like we’ve talked about previously. Um, are they having enough fluid? You know, if you’re not staying hydrated, it’s really hard for your stools to have enough water in them to be able to pass easily. Um, and is that person quite sedentary or are they more active? So, we know that sedentary people are more prone to constipation. Um, and just adding in things like some walking or, you know, getting up your steps can really assist with constipation. So generally, that’s where I like to start. 

Leah

00:03:02 – 00:03:12

But it’s not necessarily the thing that’s going to move the needle quite far, for most people. So, what do you do? What’s your next step after you check that stuff? 

Aidan

00:03:12 – 00:03:49

Yes. Checking those things, obviously the first, like they’re obviously really important. Like exercise one’s huge. Like if I get somebody who is sedentary, and they have constipation like this could be an easy win. Like if you like walking or general exercise like yoga and stuff like that. The trick is, as you said, like, what happens if you get somebody who has a good fibre intake? And also on that topic actually, the research shows that people have constipation on average self report having similar fibre intakes to those who don’t have constipation. So just chucking out the standard advice of anybody you hear having constipation like you should have more fibre, like they’re already likely to be doing similar things anyway. Um, 

Aidan

00:03:50 – 00:04:24

what if they drink enough water? And what if they already exercise? Like as I said, that person was a bikini athlete, like they’re already training consistently and stuff like that and like I’ve had a lot of people in that space since then. So, like, what are some stuff that moves the needle? Um, looking deep through the research, three things massively stood out to me in terms of really helping things. The first one, which not a lot of people talk about but is relevant, is kiwi fruit. So, the recommendation is two serves of kiwi fruit per day, and the reason why this works is because of an enzyme called Actinidin which basically just stimulates the bowels. 

Aidan

00:04:25 – 00:04:53

As I said, I care about outcomes. So, the next step really is like, well, how much does that improve things by? In terms of frequency, it improves it by 45% on average. That’s moving the needle. That’s a significant improvement and also one of the other things I care about is it reduces all other symptoms, like gas and bloating and all those other things, which is really, really important because touching on that fibre topic. When you look at the research on insoluble fibre, that 

Aidan

00:04:53 – 00:05:25

is very hit and miss. Like increasing insoluble fibre, sometimes it makes all symptoms worse. Sometimes it improves frequency that makes all the other symptoms worse. So we’re really looking for things that make all the symptoms better, and kiwi fruit falls into that category. The other thing to touch them very briefly is. it also happens to be low FODMAP. Everything I’m going to mention here is going to be low FODMAP because there’s other options. People talk about, like pear juice and prune juice and all those other options but they’re high in sorbitol as well. So, it’s like if sorbitol is playing a role in gas production and stuff like that, 

Aidan

00:05:25 – 00:05:41

we might not want to go down that route. So, this is more of a sure-fire thing. The next thing, I don’t use this as much but I am pretty big on, is linseed/flax seed. It’s my understanding that they’re actually the same thing. I don’t know if that’s 100% sure, but I think they are the same thing. 

Leah

00:05:41 – 00:05:42

They are. They are the same thing.

Aidan

00:05:42 – 00:06:20

Good, thanks for confirmation, and the recommendation is about 10 to 20 grammes of these per day. I really do recommend starting low and building up. That’s actually a good recommendation with anything fibre related to start off with as well. You do not want a dramatic increase really quickly because that could make symptoms worse. Um, once again, it improves all symptoms, including frequency and everything else. The mechanism is kind of hard to interpret. It seems to mostly just be based on the soluble fibre content. And if it’s that simple, it’s interesting why linseed/flaxseed stands out so much. But it makes sense, and the other thing to be aware of is that 

Speaker 0

00:06:21 – 00:06:55

the benefits accrue over time. Like Kiwi fruit, because of the enzyme, usually you will notice benefits within at least a couple of days or at most a couple of days sorry. Linseed and flax seed like if you put together a study and you’re measuring things over a one-month time frame a day, at day 30 symptoms are still improving. So, it’s still a long term thing, and then the last tip I’ve got that really moves the needle. This is the most boring one because, like everyone probably already assumes it but nobody actually tries, is a Metamucil or psyllium husk, which is what Metamucil is based on. Both of them are the same thing. 

Aidan

00:06:56 – 00:07:35

so 10 grammes of psyllium husk per day improves frequency by an average of 64%. That’s massively moving the needle. Improves all other symptoms as well, even more than Kiwi fruit and stuff like that as well. That is such a huge thing and like to share a story that I think is relevant for this because it is boring advice. But like to share a story on this. I saw a dietitian, I think she was an RD in the USA, tell a story about how she went to see a doctor about her constipation and she wanted medication because she’s like she’s smart, she knows nutrition, and she’s like she couldn’t sort it out herself. So she’s like, I need medication and the doctor was like, try Metamucil and then come back to me. 

Aidan

00:07:36 – 00:08:09

She was really frustrated by that. Like she saw it as a lack of care. And she noticed no improvement in symptoms. She didn’t actually try the Metamucil, but she noticed no improvement in symptoms, so she was really frustrated. So she went back to the doctor, and she, like, was like, I’m going to ask for medication this time. I’m really going to ask for medication this time. And the doctor just brushed it off again. It’s like did you try Metamucil? And she was really sheepish, and she was like, No, I didn’t try. And he’s like, I’m not giving you anything until you try it. And she tried it and it solved her constipation. And the whole point of that is just to be like, Yeah, it is obvious, 

Aidan

00:08:09 – 00:08:15

but you should still try it. You should still try that first before moving on to other stuff.

Leah

00:08:15 – 00:08:52

100% and I think for me a lot of the reason why that’s not the first thing I recommend to clients is because of that reaction is like, oh, come on, like don’t give me the oldest trick in the book like I want something new. So, I personally tend to go for the Kiwi fruit or flax is like, you know, a good option that I think someone would be interested in. But yeah, if something, you know, there’s a reason why it is like the standard, or why it’s like the classic option is because it does work a lot of the time, so you know, why not give it a go? Um, I suppose moving onto the things that are, I suppose I recommend less commonly or more so for people with, 

Leah

00:08:52 – 00:09:37

like, really chronic severe constipation. There’s a couple of options that I could potentially use there. Um, the first one is magnesium. Um, so it’s definitely not a long-term option. Um, but we do know that having over 300 milligrams of magnesium citrate can have this kind of laxative effect. So, it basically draws water into the stool, making it easier to pass. So, you know if someone’s been really, you know,  constipated for quite a while, and they’ve done the flax seed stuff and you know it’s really not helping, and they do need to kind of just move that bowel movement through, um, then going for something like magnesium citrate could be a good option. But again, it’s not something you want to be taking all the time. It’s not a daily solution, 

Leah

00:09:37 – 00:10:26

um, but can be used as, you know, one off when things are getting a bit severe and uncomfortable. Um, one that I do tend to use quite frequently as well is stool softeners for when things are quite chronic and severe. Um, so stool softeners are often confused with laxatives, but they are very different, so you can get stool softeners that are with laxatives, and that is a really common thing to kind of find in the pharmacy when you are seeking a laxative, but they are different. So, laxatives are more of that stimulating effect on the bowel and then should not be used long term. Um, whereas stool softeners actually use that osmotic effect to draw water into the stool making it easier to pass. And for the most part, you can actually use stool softeners ongoing without any, 

Leah

00:10:26 – 00:11:13

you know, negative consequences to gut health or bowel movements later on. So, if you use laxatives long term, obviously that kind of can create this effect of like a lazy gut or lazy bowel. Um, where you then rely on those laxatives for ongoing treatment of your constipation. Stool softeners are not like that. Um, there’s definitely a couple of different kinds of stool softeners that you can get. The first one I came across was Coloxyl, which is docusate sodium so it basically is considered, like, safe for long term use. But it’s not my preference because it doesn’t tend to have quite as good of an effect as another kind of stool softener which I know as the brand name is OsmoLax. That’s like 

Leah

00:11:13 – 00:12:01

in Australia. That’s what we tend to have access to, Um, but it’s polyethylene glycol and research shows that long term use is again safe. But it is really effective for chronic constipation and it’s not going to be that really explosive sudden bowel movement you get from laxatives. It’s that you take it for a few days, and then eventually it does have an effect, and then you can take it ongoing, um, to prevent constipation from occurring in the first place. A huge place where I will use stool softeners is if we’ve worked out that someone’s constipation is related to things like mental health or stress, things that are not easy to fix. So, when we can’t really get to the core root of that problem right away, these can be a good interim solution for sure. 

Leah

00:12:02 – 00:12:04

Have you ever used still softeners in practice? 

Aidan

00:12:04 – 00:12:46

So, I’ve only used it for people doing weight cuts like if they’ve had a history of constipation during a weight cut, which is obviously not ideal when you’re trying to make weight. Then, yes, I’ve used it for that. I haven’t used it for other people. But as an example that comes to mind, and magnesium citrate also comes into this kind of category as well, either of these two options would work, is that if you are having somebody slowly increase their fibre intake, or you’re trying to use any strategy that involves what they call adding bulk to the stool due to fibre, you probably want to clear out what’s in there to start off with. Otherwise, you might be making the problem worse. So, like it’s very clear that, like a treatment like that 

Aidan

00:12:47 – 00:13:01

would make a lot of sense for somebody who has had ongoing issues for quite some time and then not starting from a good baseline. It kind of allows almost like a bit of a reset, even if it isn’t related to mental health and stuff like that. Even if it isn’t an easy fix, it makes sense to start with something like this too.

Leah

00:13:02 – 00:13:32

So, if you have that build up already in there, adding flax seed onto that as extra fibre could just be doubling up on the problem. So, you do need to, at some point, maybe clear that out before starting on those, I guess, less medical options for sure. Another thing we tend to look at is FODMAPs. So, we’ve so far done a couple of podcasts on FODMAPs in general. We’ve talked about how it is really effective for IBS where the symptom is predominantly diarrhoea. 

Leah

00:13:32 – 00:14:10

Um, but there are definitely cases where it can help for, um, IBS constipation. Uh, so FODMAPs can lead to a build-up of gas in the gut and that can actually compact the stool, making it harder to pass. So, sometimes, you know, going on a lower FODMAP diet and trailing that can have an effect on someone’s constipation. It’s just that it’s effectiveness is definitely lower for constipation than it is diarrhoea. Yet it’s still something that’s in that realm, and we will generally think about, but not the first thing I tend to jump to when I’m thinking constipation, 

Aidan

00:14:10 – 00:14:36

for sure. And other stuff that, I guess, I’d add overall is it makes sense to play around with your amount of fibre. Like there have been some studies having shown that decreasing fibre helps with constipation. It’s not something I go to, but it’s like if you’ve tried one approach for ages, and you’re still having issues it could be worth playing around with another one. Like whatever you do, try and be consistent with it for a decent period of time to say that it matters. But you can play around with the other approach. At the other end of the spectrum though, like it does make sense to just try and 

Aidan 

00:14:36 – 00:15:03

quote unquote improve overall gut health. Focus on getting these good prebiotic fibres in through food, having that greater than thirty different plant based foods per week that I always talk about coming in, and just trying to build a good overall gut microbiota. Something that I was thinking about the other day, so I’ve read this book called Fibre Fuelled. I don’t know how to say old mate’s name, Dr. B. is what he goes by, and like guthealthMD or something on Instagram. I can’t vouch for the book as there’s a lot of stuff in there that, like they’re like, 

Aidan

00:15:03 – 00:15:33

I can’t fully vouch for it. Like there’s a few times it was like, oh, anytime somebody’s got a gut health condition, I just completely cut dairy. That’s my first move. Like little things like that and like, that’s probably not my first move, but whatever. But like one of the good points that he made is that he’s always encouraging, obviously, fibre, the name of the book title, but like beyond that, he’s always encouraging diversity of fibre. And going back to one of the points I said earlier, I often will use Metamucil or psyllium husk with a client or something like that in that kind of position and just use that. One of the points he made is for himself is he has 

Aidan

00:15:33 – 00:16:06

Metamucil one morning, and then he has Benefiber, which is like based on wheat dextrin, another morning and then he has a different fibre kind of supplements every morning. So, he has five different fibre supplements, and that’s even the diversity of those types of fibre rather than just hammering this one thing. It’s like, does that really matter? Will that lead to better outcomes? I can’t say that’s going to. It’s a really interesting perspective that I’m always aiming for greater than thirty different plant based foods per week. It’s like, well, we know Benefiber gets pretty much the exact same results as Metamucil, it is very similar, but it’s a different source of fibre. There’s probably no downside to it. And there could be upside as well. 

Leah

00:16:06 – 00:16:14

Yeah, totally. Um, I suppose the last thing to touch on is there anything else that you feel really moves the needle in constipation? 

Aidan

00:16:15 – 00:16:50

Uh, nothing really comes to mind. Obviously, stress management comes into play. Something I think about a little bit in terms of exercise as well is that often the people I see who exercise a lot and have constipation are like pretty heavy resistance trainers or like elite athletes, like people who are not doing gentle exercise. They’re doing pretty aggressive exercise, and it seems to be a lot of benefit to constipation comes from that gentle exercise where it’s yoga, whether it’s walking, whether it’s whatever, that’s just a common theme I see. I don’t know if that matters, but it is something that stands out. 

Leah

00:16:50 – 00:17:11

Another thing would be, I guess, the good old fashioned prune juice. So that’s a common one that I know like my grandparents use. Um, I tend to avoid any, I suppose, high FODMAP options when it comes to IBS or like constipation specific treatment. But it’s something that’s been used 

Leah

00:17:11 – 00:17:13

so effectively 

Leah

00:17:13 – 00:17:25

and it can be quite effective, I suppose. Would it be best to use that in a time where you are trying to just clear yourself out before moving on to a more long-term solution? Do you use it at all? 

Aidan

00:17:25 – 00:17:29

So, I actually don’t use it with any of my clients. But like I see other dieticians use it and like, 

Aidan

00:17:30 – 00:17:30

I think 

Aidan 

00:17:30 – 00:17:38

it’s just one of those things to try out. If you try it out and it works for you, why would you worry about it? I don’t know. If it works, it makes sense. 

Leah

00:17:38 – 00:17:40

Yeah 100% 

Aidan

00:17:40 – 00:17:59

Cool. Okay, well, that wraps things up for episode 11. Um, if you have been enjoying this and you happen to use iTunes, which, according to statistics, is 76% of people who listen to this, could you please give us a review? There have not been that many reviews. And we would really, really, really appreciate it if you could do that. Thank you.